Pelvic health problems affect almost one-quarter of women, and the incidence increases with age. Most women leave pelvic health issues to their general OB/GYN. But in fact, complete diagnosis of these issues is complex, and sometimes can only be fully addressed by a specialist known as a Urogynecologist: an OB/GYN who is certified in Obstetrics and Gynecology as well as Female Pelvic Medicine and Reproductive Medicine (FPMRS).

Cherokee
Women’s Health is the only Southeast OB/GYN practice with three physicians double
board-certified in Female Pelvic Medicine, drawing in women from all over the
country – 27 states in 2018! Cherokee Women’s is THE resource in the Southeast for
women with pelvic health issues – before, during, and long past the
child-bearing years.

Women travel from all over the country to visit Cherokee Women’s Health

What is Pelvic Health?

Pelvic health includes the functioning of every organ and structure in the pelvis, and encompasses four broad categories:

1. Normal functioning of the bladder, and the portion of the digestive system that includes the bowel and rectum.

2. Well-supported reproductive organs. A woman with good pelvic health will have no uncomfortable feeling of sagging, “falling,” or pressure.

3. No significant pain or dysfunction in the pelvic area, whether from aging, childbirth or past injuries due to surgeries or accidents.

4. Good sexual function and sensation.

The key foundation for pelvic health is the “pelvic floor” — a versatile set of muscles that works 24/7, supporting the uterus, cervix, vagina, bladder and rectum.

Almost one-quarter of women face pelvic floor disorders. Certain risk factors indicate that a woman should be on the lookout for needing further diagnosis and treatment.

Pelvic Health Risk Factors

Pregnancy/childbirthChildbirth puts excessive strain on the pelvic area during delivery.

HeredityHaving a mother or sister with PFD (Pelvic Floor Disorder) puts a woman at higher risk for developing pelvic health problems. Caucasian women are more likely to develop prolapse and to have bladder leakage. African American women are more likely to have leakage related to urgency.

ObesityOverweight or obese women have increased pressure on the bladder and frequently lack strength in their bladder muscles

You are giving life to someone who is helpless, and it requires ALL of your attention…you just can’t have a bad day. You just can’t. – Dr. Peahen Gandhi

Dr. Peahen Gandhi and her Medical Assistant Jourdan worked together for years at Cherokee Women’s Health Specialists. Jourdan also saw Dr. Gandhi for her annual OB/GYN care, as Jourdan and her husband planned to start a family.

When Jourdan became pregnant with twins,
it was Dr. Gandhi who gave her the surprise announcement and who began Jourdan’s
pregnancy care. Jourdan’s perspective as a young woman with a high risk twin pregnancy
is told in her video interview here. Yet for Dr. Gandhi, from the moment she
diagnosed Jourdan’s pregnancy, her friendship and working relationship with
Jourdan became something much more complex –

Jourdan was now a high risk patient under Dr. Gandhi’s direct care.

Danger
at 28 Weeks: “Something Was Off”

As it turned out, Jourdan’s pregnancy would
not be an easy one. Early contractions at 22 weeks sent Jourdan to Northside
Hospital Cherokee, where she was treated and the contractions eventually
stopped. But at 28 weeks came the most dangerous moment of the pregnancy.
Jourdan came in for her check-up having contractions. Medication could not stop
them. And she was already dilated.

Dr. Gandhi knew that Jourdan’s tiny twin
boys were not yet ready to survive outside their mother’s body. She shares the
experience from a doctor’s perspective:

“Jourdan is my medical assistant. She’s
seen me practice for many years now – we’ve worked together for a really long
time. She knows exactly what to say
to me to not worry me.

“But that morning something was off. She
didn’t feel well that day. She said she was feeling some pressure – and that’s
not uncommon. For our pregnant patients, we sometimes put them on the monitor
to see if they’re having contractions.

“But when patients have twins, we’re a
little extra careful. Because they don’t have the typical symptoms. Sometimes
they may not have contractions but they could still be dilated.

“So I asked her to get an ultrasound and
examine her.”

Ultrasound
Shows Contractions and Growing Dilation

Dr. Gandhi describes the next moments,
when it became that things were not going well. “During the ultrasound, Brenda,
our ultrasonographer who’s been with us many years – twelve-plus years – said, ‘You
know Dr. Gandhi, I’d like to you to come in here and take a look at this.’”

Dr. Gandhi smiles a bit. “And that’s never
a very good sign when she asks me to do that.

“Looking at the ultrasound, I could tell
that there was only a very thin layer between the presenting part of the baby and
the cervix. This means that the cervix has either started to dilate or shorten
– there is now very little distance between the bag that holds the baby and the
cervix.

“I did a speculum exam and I was able to
see right away that she was dilated.”

Dr. Gandhi pauses to consider her
personal relationship with Jourdan. “Of course, if this is someone you know
very well, you don’t want to worry them… I took the speculum out and I told
her, ‘I think we’re going to send you to the hospital for some observation.’
And she looked at me, kind of worried, and I said, ‘Oh yeah, it’s probably
going to be fine.’”

Balancing
Clinical Objectivity with the Personal Relationship

Dr. Gandhi confides that at this point she
viewed Jourdan’s pregnancy as “a ticking time bomb.” Every decision she would
make for Jourdan’s care was weighed to give her and her babies the best chance
of a safe and successful delivery. At 28 weeks, the contractions and dilation were
life-threatening for the babies.

“In the back of my mind, I know what all
this means. She’s very early, she’s only 28 weeks, she’s already 2 centimeters
dilated and she is having twins – which is all
a package – it’s kind of like a ticking time bomb.

“You have to be kind of conservative
because the babies are early, but you don’t really know how much time you have
in order to make sure that the babies have the best chance of surviving, to do
well should they be born early. And at the same time you have to make sure
you’re taking the precautions needed to get her to the right facility and be
around the right pediatric care.”

Dr. Gandhi called the ambulance and had
Jourdan taken directly from the office to Northside Hospital, where Dr. Gandhi
met her shortly afterward.

“Her whole family was there – she has a
very large, loving family – and of course she’s having twins, so they’re all
very excited – but NERVOUS…”

“As her physician, I have to talk to her,
be objective and explain the things that can go wrong – but at the same time
make her feel comfortable. And that’s very hard to do – especially when you’re
dealing with babies that are not even two pounds, advising her about the risks
of them being born early – you’re trying to stop her contractions and also make
her feel calm.

“I did send her to Northside Atlanta,
where they have a NICU that’s equipped to handle very early care like that. We
will now have the ability here at Northside Cherokee to handle preemies – as
early as 32 weeks.

“So we called the ambulance. I was in
contact with her the whole time.”

Pre-Term
Labor With Twins

Dr. Gandhi pauses a moment to talk about
the clinical aspect of twin pregnancy and pre-term labor. “Pre-term labor
happens in 11-12 per cent of pregnancies – and it’s scary because sometimes –
many times – it’s a false alarm.

“But when it does happen, and it when it
happens that early, it is so important to recognize it, and to intervene as
quickly as possible. We want to give the baby – or potentially babies – enough
time to get prepared so that the pediatric staff and the NICU staff have the
best chances of providing great survival.”

In this instance of pre-term labor at 28
weeks, Jourdan’s contractions were eventually stopped and she was able to go
home. Dr. Gandhi ordered Jourdan on strict bedrest. As her physician, she
remained watchful and called Jourdan every day, knowing that her medical
judgment could be the critical factor keeping Jourdan and her babies safe for
the remainder of the pregnancy.

Finally Jourdan went into labor at 33 weeks.
Dr. Gandhi relates that she safely delivered her twin boys by C-section. The
babies were cared for in the NICU at Northside Hospital Cherokee for several
weeks until they were breathing and eating on their own, and finally able to
come home.

“The way technology is now,” Dr. Gandhi
explains, “we have the capability of take care of these very, very premature
babies in the NICU. But each moment the mom is away from the baby – because the
baby is in the nursery – it’s heartbreaking. I sympathize with women who have
to go through this. Not only because I’m an OB/GYN but because Jourdan is a very
close friend –

“And I saw her through THAT side – not
just the medical side.”

Obstetrics
– Joy and Emergencies

As the interview concludes, Dr. Gandhi reflects
on caring for patients in the specialty of Obstetrics. “As obstetricians, we have
the JOY of delivering babies and everything is going fine, everything is normal
and everybody is excited…

“But we get to see emergencies, too, and
it’s so hard because you are giving life to someone who is helpless, and it
requires ALL of your attention. And you have to
– well, you just can’t have a bad day. You just can’t.” Her voice is
serious.

“The patients rely on you – and the baby relies on you.”

Then Dr. Gandhi relaxes a bit and says
with her characteristic smile, “Well, it was a little intense. But in the end
it all worked out – Jourdan was completely stabilized. She ended up delivering
at 33 weeks. And they did great – her boys, Briar and Wyatt.”

She fights through a hint of emotion and
finishes with a smile. “It’s such a blessing to have someone in our own
Cherokee Women’s family have a great outcome like that – and me being a part of
it –

“Nothing in the world can prepare you for going home without your children.”

Jourdan Adams is calm as she describes her high risk pregnancy, the birth of her tiny twin boys as “preemies,” and the long weeks they stayed in the Northside Hospital Cherokee NICU (Neo-Intensive Care Unit). The emotional ups and downs will sound familiar to any mother who has given birth to a premature baby.

“The pregnancy was good – up until about 22 weeks. That was the first time I had to go to the hospital.”

Jourdan and her husband Tyler had been trying to get pregnant for a couple years, so when Jourdan’s home pregnancy test read positive, she went to the OB right away. Jourdan’s choice of a doctor was simpler than it is for many women. As a medical assistant for an OB/GYN practice, Jourdan made an appointment with Dr. Peahen Gandhi, the physician with whom she had worked so closely over the past few years.

“We came in super early – and then again at 5 weeks, when we saw 2 sacs! And that was how we found out we had twins.”

She admits the twin pregnancy came as a shock. “I just remember looking at my husband and saying, ‘Oh my gosh – what are we going to DO?!’ And my husband was so good, he just said to me, ‘Babe, we’ve got this.’

“But I was thinking, ‘No, you DON’T!!! You have no CLUE what we’re in for!”

Pregnancy of Hospital Trips and Bedrest

Jourdan relates that early on in the pregnancy she had a small bleed, which – she quickly adds – is “not unusual. ” But at 22 weeks the real trouble started. “I was feeling kind of weird at the office one day. Dr. Clay gave me an ultrasound and put me on the monitor – and they realized I was having contractions. She sent me to the hospital.”

At Northside Cherokee, Jourdan saw her high-risk specialist, who put her on fluids and sent her home, anticipating that the contractions would settle down once she was off her feet.

“But the next day I was still having contractions, regular – every 10 minutes. I went back to the hospital, and got three injections of terbutaline.”

Jourdan confesses, “Well, it was so early, I just wasn’t worried. I was thinking, ‘They’ll fix it… this is just normal, right?’ I never really felt super fearful they were coming.

“Then I was put on bedrest until 24 weeks – because that is viability. At that point I was allowed to work for three days.”

But at Jourdan’s next check-up, an ultrasound by Dr. Gandhi revealed a troubling development. “We realized my cervix was shrinking. After that, I was on bedrest for the rest of my pregnancy.”

An Emergency Ambulance Ride to Atlanta

At Jourdan’s 27 week appointment, there was more trouble. “I was dilated, my cervix was shrinking further. They sent me to Northside Hospital Cherokee. The monitors showed I was having regular contractions – that I wasn’t feeling. They gave me more terbutaline – and then magnesium, which made me feel really sick. It was horrible.

“Dr. Gandhi came to check on me when got out of surgery. She took a look, and then she sent me straight to Atlanta [Northside Hospital Atlanta] – because she was afraid the boys were coming.”

Jourdan admits this time she was scared. “Dr. Gandhi said she was transferring me and I didn’t know she meant I needed to go by ambulance. It was terrifying. I was hooked up to all these machines – IV, catheter…We got there and I filled out all the paperwork. There I was, a at 27 weeks, looking at birthing my twins.

“But after a few hours at the hospital, I got settled and the contractions stopped. They let me go home again. And after that I was on bedrest until 31 weeks.

Waiting Alone, the Dog By Her Side

Jourdan describes the final weeks of bedrest as lonely.

“I was sitting by myself all day. I came down from my bed every morning. Tyler had to work of course – he was saving up his sick days for when we had the babies. He would help me downstairs, make my breakfast, and then he was gone the rest of the day. At lunch, my mom, or his mom, would come over to make me lunch and sit with me a while.

“I sat and I felt very hopeless. Dr. Gandhi called me every day to make sure I wasn’t going crazy. My husband was very supportive. But I felt so hopeless. I couldn’t do anything.”

Jourdan smiles when she mentions her dog. “We have a bulldog. And he sat with me every day. I made sure to put his bed right beside me, so I had him with me. He really did help me.

“My brother offered to get him and take care of him so I wouldn’t have anything to worry about – and I said ‘No – You can’t! He’s the only company I have all day long!’”

Jourdan made it to 33 weeks. And that’s when her boys decided to come.

Early Labor – A Rush To C-Section

Jourdan recalls the morning of the day the twins were born. “I told my dad, ‘I feel weird, I just feel off.’

“I went to the High Risk Specialist, and I was feeling my contractions in the waiting room. That was the first time I’d ever felt them. Then Dr. Gandhi came in to evaluate me – I was already at 4 centimeters. Dr. Gandhi announced, ‘We’re going to do your C-section within the hour.’

“All of a sudden it seemed like I was surrounded with so many nurses. I looked over at my husband and he was getting fully scrubbed in. I thought I had prepared myself, but it happened so fast. Our families got there really quick and they were able to say ‘hi and bye’ to me – and then I was taken back to the OR.”

Jourdan was admitted to the hospital at 7 pm. And by 9 pm her twins were born, at just 33 weeks. Briar John was 4 pounds, 10 ounces, Wyatt Graham, only 4 pounds, 5 ounces.

Jourdan describes the uncertain moments after the delivery, wondering, Would her babies be okay?

The Cry Of Her Babies

“Dr. Gandhi showed me the boys right away, and I heard them cry. I had been anticipating that moment for so long, and I was so scared, so to hear them cry, I was like, ‘Okay I can breathe. They are okay.’

“I had two separate NICU teams. They were doing a full evaluation, and that was hard to wait for them to finish to hear how the boys were. My first baby, Briar, had to be put on a C-PAP [a device providing Continuous Positive Airway Pressure] – because his lungs weren’t fully developed. It was helping him breathe. So when I first saw him, he had the tubes stuck up his nose, and around his face. He just looked horrible. And I could only see him for a second, and then they had to take him upstairs.

“And then my second baby, Wyatt, he was fine. And he was the smaller one! And I got to see him for a little bit. They laid him on my chest. – and in that moment, everything just stopped for me – nothing else mattered. I didn’t hear anything, I don’t remember Dr. Gandhi sewing me back up… none of it! I just remember him being on my chest, and we were able to sit like that for just a few minutes. And then they took him to the NICU.”

Jourdan remembers being in the recovery room for a few hours, where the Neonatologist came in to talk to her about her boys, and that Briar would be on the C-Pap for 2-3 weeks.

“Dr. Gandhi sat with me the whole time, and then they took me to my room. And I remember them telling me, ‘Normally after a C-section you can’t get up for 12 hours.’

“But I had hardly seen my babies!!! And I just said, ‘THAT’S NOT going to happen. I’m going to get up, and you get whoever you need to, because I’m getting UP!!!’ So I got up about 4 hours after my surgery and I went up to the NICU and I was able to see my boys for a little bit.”

Northside NICU, Close To Home – “A Blessing”

Jourdan sits now with her twin boys beside her, each sound asleep in a car seat. She looks bright and well-rested. No one would guess that she has recently had a dangerous pregnancy, or even that she is the mother of infant twins born just 3 months ago.

We ask her, “How did you handle the waiting period before the boys could come home?”

“I didn’t anticipate, obviously, how everything went. It was hard to see them in the NICU, especially Briar, because he was doing this whimpering thing – they said he wasn’t in pain, that he was just getting adjusted to the C-PAP.

“I stayed in the hospital as long as I could – I stayed 4 or 5 days. And then they were like, ‘You need to leave. You cannot stay here any longer – you are fine, GO HOME!’

“I was anticipating that day, having to leave them – which was the hardest thing. And I had other moms tell me, you are going to be heartbroken. And I had tried to prepare myself for it, but nothing in the world can prepare you for going home without your children.

“Luckily, we only live 5 minutes from Northside Hospital, so we were there every single day, all day long. We got there every morning and only left for lunch. The boys had feeding tubes for the first week and a half, and we wanted to hold them while they were being fed so they would associate food with Mommy and Daddy. And after that we were working on bottles.

“The NICU team was so wonderful. The boys had their own room – so it was really nice.” She laughs. “We could kind of spread out.

“It was a blessing that we were in Cherokee County. I couldn’t imagine them being in Atlanta, and having to drive THAT every day. It was exhausting to be there all day long, and still recovering from surgery. It takes an emotional toil.”

Advice for Mothers of Preemies

We ask Jourdan: Do you have any advice or words of experience you would share with mothers of premature babies?

“I would get up in the middle of the night and pump in their nursery, and I had this song I would play for myself, by Darius Rucker, “It Won’t Be Like This For Long.” And I just played that over and over, and told myself, “It won’t be like this for long. The boys will be home one day.

“And I would just picture what their lives were going to be like – us on the baseball field, or whatever they will want to do – and I just dreamt about THAT. Instead of thinking about them in the NICU and everything they were going through.

“And also I put blankets under the boys in the hospital – the nurses did this for me – and they allowed me to take those home with me so I could smell them when I was at home. It kind of gave me that comfort – that they were there with me.

“In the NICU, I was trying to be very hands-on. I was always changing diapers, giving them baths, feeding them. I wanted to do those things, like I was at home. And it made me feel like I was somewhat normal. We also had a lot of people come visit them – which helped me, too. Because I kind of felt like I was able to show them off, like it was NORMAL – because usually people come to visit them when they come home. So I really liked that I could show them off, and tell people how good they were doing, and all their improvements.”

Endometriosis is the third leading cause of infertility in women of childbearing age. This disease affects 1 in 10 females from the ages of 15 to 44. It impacts more than 11% of women in the U.S. alone and is often times not diagnosed until a woman is in her 30’s or 40’s, so they may have it and not even know.

What is Endometriosis?

The inside of your uterus (womb) has a lining of tissue called the endometrium. This is similar to that thin layer of skin-type material attached to the shell you sometimes see when you peel a hard-boiled egg.

When you have a normal menstrual cycle, this uterine lining thickens to get your uterus ready to house a baby. Its purpose, if fertilization occurs, is to keep an embryo latched on to itself for nine weeks, providing nourishment until the mother’s blood supply through the placenta can take over the job.

If pregnancy doesn’t happen that month, menstrual blood sloughs away that barrier and your body begins to rebuild a new one in preparation for the possibility of pregnancy the next time.

With endometriosis, endometrial tissue grows and attaches itself in different places outside of your uterus where it doesn’t belong. Like the one in your womb, this tissue is stimulated during the menstrual cycle, but it doesn’t break down. Instead, it remains, causing pain, irritation, and possible scarring which can eventually lead to adhesions, a type of scarring that can cause different organs to fuse together.

Endometrial tissue can be found in:

The pelvic cavity lining

Ovaries

Fallopian tubes

Uterine support structures

Outer uterine surface

Rectum

Bladder

Bowels

Cul-de-sac (a space that is located behind the uterus)

Outer uterine surface

Peritoneum

In very rare cases, it has even been found on skin, and in the lungs and brain.

What are the Symptoms of Endometriosis?

Many women have none. Others may suffer a little discomfort, while yet others may experience extreme, debilitating effects. Symptoms include:

Moderate to crippling pain during menstrual cycles that worsens over time

Bloating

Sexual discomfort felt deep in the pelvic area both during and after intercourse

Constipation

Lasting, chronic pain in pelvis and lower back

Intestinal pain

Digestive problems, especially during menstruation

Nausea

Diarrhea

Infertility

What Are the Heath Risks of Endometriosis?

Although endometriosis is neither contagious nor cancerous, left alone it can continue to expand in places where growths should not appear. Unchecked, this may lead to the following problems:

Swelling and pain: Because these implants of endometriosis are appearing internally where they don’t belong they cannot be expelled from the body. They can cause tenderness, inflammation, swelling, irritation, and even excruciating pain depending on their location.

Infertility: Adhesions or scar tissue involving the fallopian tubes may block access to eggs, or damage both the sperm and egg during ovulation. Adhesions that have formed may also make pregnancy difficult or impossible.

Cysts: If endometrial tissue grows in the ovaries and traps blood, painful, blood filled sacs called cysts may develop.

Intestinal and bladder problems: Continual, unchecked growths in these areas can result in major health issues.

Who Can Get Endometriosis?

Any female who has begun to menstruate can get endometriosis. In the past, women were often not diagnosed until 30 or 40 years old. Now, doctors know to be on the lookout much earlier, starting in the teens to 20’s. Although endometriosis is not overly picky about which woman’s body it chooses to inhabit, you have a greater likelihood of suffering from it if you have:

What Causes Endometriosis?

No one really knows although research is intense and ongoing. Some theories include:

Genetics: Women in the same family are often diagnosed with the disease, so it is assumed that genetics play a role.

Hormones: Estrogen spurs endometrial tissue production, so there is a hormonal link.

Menstrual flow problems: Referred to as ‘retrograde menstrual flow’, this means that, since tissue is expelled through the fallopian tubes into the pelvis, it can end up in other parts of the body. This is the most popular theory

Compromised immune systems: A weakened immune system may not be able to perceive or fight off the growth of endometrial tissue. Endometriosis has been found in that many women with certain cancers and lowered immunities.

Invasive surgery: Transfer of endometrial tissue during certain abdominal surgeries is a possibility.

Transportation of cells: Some experts think that endometrial cells ‘hitchhike’ with tissue fluids and blood cells to other parts of the body.

How is Endometriosis Diagnosed?

The only way endometriosis is diagnosed is that it must be seen at the time of surgery. When someone presents with symptoms of endometriosis, initial workup may entail:

Complaints you are experiencing

Family and your own medical history

Evaluating all medications, herbs and supplements you are taking

Blood and urine tests if needed

A pelvic exam

Ultrasound

Surgery is then performed as necessary.

Is There a Cure for Endometriosis?

There is no cure, but endometriosis can be treated and managed. Options depend on your particular issues and symptoms, and whether you still want to become pregnant. They range from medication to surgery.

What Are the Treatments?

Your doctor will most likely try the following:

If pain is your major complaint, over the counter anti-inflammatory medications might work, or stronger prescriptive medication may be dispensed if needed. If you are averse to those, meditation, acupuncture, chiropractic help, and certain supplements may be beneficial.

If you are not trying to get pregnant, you may be prescribed a birth control pill minimizing menstrual occurrence or eliminating periods altogether. Another option is insertion of a long-term intrauterine device (IUD) to prevent pregnancy for up to five years. It may not, however, reduce bleeding and endometrial pain for its complete duration.

If you want to get pregnant, there are medications that may help. They stop the hormones that prod the body into ovulating, putting your body into a temporary state of menopause for a few months to control endometriosis growth. When this medication is stopped, menstruation resumes, allowing you a better chance of success for pregnancy.

If a possible fallopian tube blockage is suspected, a test called a hysterosalpingogram (HSG) may be performed to confirm obstruction. Surgery may follow to correct the problem, or another bypass method to achieve pregnancy, such as insemination or in vitro fertilization (IVF) may be recommended.

Laparoscopy is the mainstay of treatment. When the implants of endometriosis are found, they are treated or removed so that they no longer are active.

As a last resort for unbearable pain and extensive growth, a hysterectomy may be performed, removing the uterus and ovaries entirely, along with all visible endometrial tissue. Hormone therapy is then started immediately to stave off additional formation. There is still a chance that endometrial development may continue, but this usually solves the problem.

How Can I Make Sure I Don’t Get Endometriosis?

There is no way to prevent endometriosis, but there is a possibility of reducing your odds by using estrogen-lowering birth control, limiting caffeine and alcohol which raise estrogen, exercising regularly, and maintaining ideal body weight.

How Can Cherokee Women’s Health Specialists Help Me?

Our entire practice focuses solely on women and their unique biology. We are trained in every aspect of women’s health care and have three board–certified, doubly accredited urogynecologists holding certification in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This means that we can diagnose, understand, and treat all feminine problems with the most up-to-date knowledge and innovations known to modern medicine.

PMS (premenstrual syndrome) affects most women at one time or another. In fact, it’s estimated that three out of four women suffer from PMS regularly.

What is PMS?

Premenstrual syndrome refers to a cluster of physical and emotional changes a woman undergoes during the two weeks before bleeding actually occurs. This time frame is referred to as the ‘luteal cycle’. At the onset of her period, symptoms usually disappear.

What Are the Symptoms of PMS?

Symptoms of PMS are numerous and may include any or all of the following:

Erratic mood swings

Abdominal pain, pressure and cramping

Moderate to severe depression

Uncontrolled aggression and hostility

Uncharacteristic outbursts of anger

Brian fog or lowered concentration

Social isolation or withdrawal

Brain fog or mental confusion

Anxiety

Fatigue

Irritability

Difficulty sleeping, insomnia

Decreased or heightened sexual desire

Headaches, migraines

Tenderness in breasts

Weight gain

Joint pain

Swelling in feet and hands

Mental confusion

Unusual cravings, changes in appetite and thirst

Bloating

Fluid retention

Skin problems

Hair loss

Gas (flatulence)

Indigestion

Obsessive/compulsive behavior such as an overwhelming need to clean, organize, etc.

Suicidal thoughts or attempts

Dizziness or light-headedness

What Causes PMS?

The exact cause has not been pinpointed, but lowering levels of the sex hormones, estrogen and progesterone are believed to be key factors. Serotonin, a neurotransmitter responsible for feelings of well-being and happiness, also drops. Though this is a natural process, and necessary to prepare the body for reproduction, the monthly depletion can cause a hormonal imbalance, wreaking havoc on women physically and emotionally. If you are experiencing extreme discomfort and PMS is negatively affecting you physically and psychologically, do not hesitate to see your doctor.

What is Dysphoric Menstrual Syndrome?

Most women have mild to moderate cases of PMS which can be annoying, or at most, uncomfortable. These symptoms cause little or no disruption in their daily routines, and usually does not warrant medical help. However, about 5% of women with PMS suffer from what is categorised as dysphoric menstrual syndrome (PMDD), which is a far more severe and negatively impacts their lives. These women require more aggressive psychological or medicinal intervention.

The criteria to meet the diagnosis of PMDD is that the patient has at least five of the emotional symptoms mentioned above during their luteal cycle. The presence of these symptoms is usually more exaggerated. These are a few that we look for:

Suicidal tendencies

Anxiety or full-blown anxiety attacks

Extreme social isolation

Impairment or total collapse of relationships

Depression

Radical mood swings

Highly pronounced or non-existent libido

Inability to focus on or perform normal daily activities and tasks

Approximately another 20% meet the definition of ‘subthreshold’ PMDD, meaning that they may be monitored diligently to avoid full-blown PMDD. This particular disorder is classified as ‘menstrually related mood disorder’ (MRMD) and may also need some medicinal or psychological treatment. Like PMS, hormone dissipation during the menstrual cycle may be the underlying cause.

Are There Any Tests That Accurately Diagnose PMS?

There are no specific lab tests to diagnose premenstrual syndrome. Instead, we’ll need to study your medical history to establish if you are suffering from it. It is very important to be completely truthful so that we can help you. We know that some of these symptoms may be frightening to you, and perhaps, at times, embarrassing to discuss, but getting the full picture allows us to give you the best and most effective advice and care. Keeping a diary of your symptoms for a few months helps.

Three of the main things we look for are:

Have your symptoms been consistently bothering you several days before your period, and recurred for at lease three consecutive cycles?

Do they usually end on or within a few days of bleeding onset?

Have they negatively impacted your day to day routine and social life?

Even jotting down specific odd thoughts and ideas, levels of fatigue, etc., can be helpful. This allows us to properly determine which hormonal imbalance is affecting you more and enable us to deal with the more troublesome symptoms accordingly. Remember to list the dates as these symptoms occurred, and exactly when menstruation itself began and ended.

Can PMS be Treated?

Mild to moderate PMS can be fairly easily managed with a few lifestyle changes and over-the-counter pain relievers. Heating pads or warm baths may help with pain, and ice packs with headaches. Topical rubs and ointments can reduce inflammation and joint pain. You may be advised to limit or completely eliminate salt, alcohol, caffeine, sugar and any artificial sweeteners as they contribute to many sleep and anxiety issues.

Other recommendations to help alleviate PMS symptoms are:

Exercise regularly, throughout the month, not just when your problems appear. Try to get at least 30 minutes of brisk walking, jogging, dancing, etc. three times a week to elevate endorphins that counteract stress, pain and depression. Endorphins like serotonin, dopamine and oxytocin, are the body’s natural feel-good narcotics and pain killers.

Acupuncture or massage: Who doesn’t feel good after a spa day and a little pampering? And acupuncture is a time- honored holistic process that has been proven to be advantageous in treating many emotional and physical menopause symptoms.

Support groups and cognitive therapy: Discussing your symptoms and emotions with other women who can relate to them can actually lower numerous PMS issues.

Proper diet: A diet rich in vegetables, fruits, grains and protein can ward off various PMS problems. Avoid carbohydrates during this time.

Getting enough sleep: Disruptive or insufficient sleep can cause additional hormonal imbalances that can augment those already affected by PMS.

Eating smaller meals a day instead of three large ones can reduce gastrointestinal discomfort.

Some herbs and supplements may counteract PMS symptoms, although some have not been studied fully so it’s always best to get these from a healthy diet instead. Before taking them, it is recommended that you speak to your physician. Though they may help, the medications you already take may interact with them and cause adverse, sometimes dangerous interactions. Here is a list of the vitamins, herbs and supplements and the symptoms they may alleviate:

Calcium for calcium deficiency that many experts believe contribute to PMS and might stave off changes in appetite, fatigue, erratic emotions, physical discomfort, and depression

For more severe PMS, your doctor may prescribe one or more of the following:

Diuretics

Antidepressants

Contraceptives

Hormone therapy

Prescription pain relief

Anti-anxiety medication

Nonsteroidal anti-inflammatory drugs (NSAIDs)

How Can Cherokee Women’s Health Specialists Help Me?

Because we deal with women’s health issues daily, we are aware of the debilitating effects of PMS. We would never minimize the detrimental influence it can have on you and yours.

We are here to offer counsel, diagnosis, empathy, and treatment, using all our expertise and knowledge of the most up-to-date information medical science has to offer. Our staff includes three doubly accredited urogynecologists with the outstanding certification in OB/GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This qualifies us to diagnose and treat all your female-related problems. Additionally, our staff includes specialists in other fields related to a women’s unique needs.

Can Your Weight Be a Factor?

Polycystic Ovary Syndrome, or PCOS, has recently received a great deal of exposure in the media. 5 to 10% of women in the United States suffer from this condition. It is one of the leading causes of infertility, yet fewer than 50% of those women are diagnosed correctly. That amounts to a staggering 5 million women!

What is PCOS?

Polycystic Ovary Syndrome is a genetic hormonal endocrine disorder that disrupts the menstrual cycle often resulting in anovulation (not ovulating) during a women’s childbearing years. Women suffering from PCOS will have disruption of normal female hormones and produce higher than normal levels of the male hormone, testosterone, (hyperandrogenism). This imbalance can cause a growth of numerous small cysts filled inside the ovaries, (hence the name “polycystic.”) The ovaries are often enlarged. These cysts are follicles that house eggs that have never matured due to the glut of male hormones inhibiting ovulation.

Most PCOS sufferers (possibly all) are also more resistant to insulin. This leads to further problems, including weight gain and susceptibility to developing diabetes.

Dr. Gandhi Discusses Polycystic Ovary Syndrome: “PCOS is often missed as a diagnosis.”

What are the Symptoms?

Because it is a genetic condition, Polycystic Ovary Syndrome can begin in utero, but symptoms only usually begin to occur when a female begins puberty. These include:

What Causes PCOS?

There are varying theories as to what causes PCOS. Because it is believed to be genetic, daughters of women with a history of it are very likely to suffer from the condition too. This may start as early as in the womb when they are exposed to the same oversupply of androgens as their mothers.

Insulin is produced by the pancreas to extract food sugars for energy. PCOS causes women to produce too much insulin. As a result of insulin resistance which, in turn, stimulates more over-production of androgens. These male hormones interfere with ovulation, impacting fertility. Male hormones then dominate female ones, resulting in some of the masculine characteristics mentioned earlier.

Since other factors can also contribute to surplus androgen development, medical science is still trying to pinpoint the exact cause of PCOS.

How is PCOS Diagnosed?

There is no actual test to diagnose PCOS. It is a matter of eliminating other disorder possibilities until the diagnosis of PCOS is reached.

Two primary symptoms of PCOS:

1) A history of skipping periods

2) Elevated androgen hormone levels (hyperandrogenic effect) alert physicians to suspect that a woman may have PCOS. Being overweight or obese strengthens the possibility, especially in females with more upper body fat. Weight gain in this area is more male-related, thus indicating the existence of higher testosterone levels.

This diagnosis is derived through:

Menstrual history

Blood tests

Gynecologic examination

Pelvic ultrasound

Evaluation of family medical history

Visual and reported confirmation of other common PCOS symptoms.

Does PCOS Cause Weight Gain and Obesity, Or Is It the Other Way Around?

Not every woman diagnosed with Polycystic Ovary Syndrome is overweight, but approximately 80% are. Other female family members tend to be overweight or obese as well. Realize, however, that PCOS causes weight gain for most patients, but being overweight or obese does not “cause” PCOS.

What are the Risks of PCOS?

Overweight and obesity alone can cause severe health problems. Compounded with PCOS, the following risks are elevated:

Diabetes or pre-diabetes: It is estimated that more than half of women suffering from PCOS will develop the disease by the age of 40. Diabetes is so serious that it aversely affects health more than almost anything else.

Cardiovascular disease and heart attack: Carrying around unhealthy weight can raise anyone’s risk of cardiovascular disease. However, compounded with other PCOS-related problems, women with Polycystic Ovary Syndrome have a 4 to 7 time higher chance of having a heart attack.

Endometrial cancer: A natural buildup occurs monthly on the uterus lining (endometrium) which is sloughed off during menstruation. Infrequent periods can result in an accumulation, leaving PCOS sufferers three times more likely to develop endometrial cancer that can occur as a result of this surplus.

Abnormal lipids: Insulin resistance, too much body fat, and the production of excessive androgens can wreak havoc on the delicate balance between good and bad cholesterol.

Obstructive sleep apnea: This is a dangerous condition of abrupt breathing cessation during sleep, characterized by snoring, gasping, choking or continual awakening. It can lead to serious issues such as hypertension, cardiovascular problems, sleep deprivation, etc. Overweight and additional male hormones contribute to the condition.

Metabolic syndrome: Women with PCOS are at higher risk for having two or more of the above risks.

Breast cancer: Though it is not proven that PCOS causes breast cancer, PCOS sufferers with a family history of it are more susceptible to the disease than those without.

Can PCOS be Controlled?

Though it is a lifelong condition and a leading cause of infertility in women, PCOS can be controlled, especially if treated early.

What are the Treatments?

Once it is established that you have PCOS, your doctor may recommend some or all of the following:

Lifestyle changes: You will be encouraged to follow a healthy diet and to exercise regularly if you need to lose weight. Even less than 10% loss can have a tremendously positive impact on ovulation and fertility problems. If you smoke, you will be told to stop. Smoking elevates androgen levels.

Medications: Birth control, other hormone-controlling drugs, and diabetes medication may be prescribed.

Electrolysis or other hair removal options may be recommended.

Surgery when warranted may be considered.

In vitro fertilization (IVF): If all other interventions are unsuccessful, your physician may propose IVF, providing you are deemed healthy enough to undergo treatments.

PCOS -prescribed medications may have strong side effects, or become more potent with steady, consistent weight loss. You will have to be monitored and tested regularly to insure proper dosage for your continuing good health.

How Can Cherokee Women’s Health Specialists Help Me?

Our broad-based establishment has specialists at your disposal to deal with all PCOS irregularities. Doubly accredited, board-certified urogynecologists holding enviable degrees in OB/GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS), nutritionists, specialists in holistic medicine, and more professionals are available. We are trained to diagnose, treat, and encourage you throughout your struggles with Polycystic Ovary Syndrome until and after a healthy and manageable level is reached.

You are the best judge of any bodily changes that might be of concern. By seeing a physician immediately when you suspect something is wrong, you stand an excellent chance of correcting troublesome symptoms of PCOS before they become detrimental to your reproductive health.

How One Patient Got “the Fireworks” Back in Her Marriage

The O-Shot is a treatment available for women which can have a positive effect on her relationships and desire to be intimate.

In the video, Dr. Litrel explains how the O-Shot works, and shares the stories of patients who have experienced changes in their relationships with the O-shot treatment. “I have one patient in her early 30’s with two children, ages 2 and 5, who experienced such a drop in her sex drive that she said it was affecting her marriage,” Dr. Litrel explains.

Dr. Litrel Shares What He Has Seen In Patients Receiving the O-Shot

“It’s quite common for women to have decreased sexual desire after having children! After meeting with my patient several times and trying different hormone approaches, and noting a normal exam, I recommended she consider the O-Shot. This is a treatment that injects platelet-rich plasma from a woman’s own blood into her genitalia to help with sexual satisfaction. It takes about five minutes for the procedure, performed right in the office, and only about 30 minutes total.

“When she returned five or six months later to my office, she let me know she was delighted with the changes she had experienced. She had the fireworks back in her marriage. She told me she “felt hope” that her children didn’t destroy her desire to be intimate with her husband.”

Dr. Litrel concludes, “This is technology that was not available a few years ago. With such an easy procedure to perform, it’s very rewarding to be able to provide this now for our patients.”

Perimenopausal symptoms can be confusing. Along with the usual hot flashes and night sweats, you may also experience some lesser known symptoms such as extreme fatigue, anxiety, and racing heartbeat, along with a myriad of other symptoms.

Lisa Haley, wife of Cherokee Women’s Dr. James Haley, understands this all too well since she entered menopause at an early age. As she entered perimenopause, she began to experience lesser known symptoms. Even married to an OB/GYN — and familiar with the classic signs — Lisa didn’t recognize her unusual physical and emotional fluctuations as being perimenopause-related.

Lisa Talks About Her Experience

We talked to Lisa about her experience with perimenopause and menopausal symptoms. She didn’t understand what was happening at the time and hopes by sharing her experience that women may better understand the signs of perimenopause.

Q: Hold old were you when you began to experience perimenopausal symptoms and what were those symptoms?

Lisa: I was only 40 when I began to feel different. If I’d had hot flashes, night sweats — any of those universally known symptoms — I would have recognized it as perimenopause right away.

I was always a high-energy, laid back, and easy-going person. I never had any problems keeping up with my kids, aged 11 and 7 at the time. I could throw myself into their extracurricular activities, volunteer for different events, look after my home, attend family functions, play tennis, exercise, and still have enough stamina left over for more. I did it all cheerfully and enjoyed every second.

The Symptoms Overtook Me

Suddenly, though, I found myself moody, snappish and easily upset. I started having frequent heart palpitations, which terrified me. Was I having an anxiety attack — or worse — a heart attack? I was young and in peak physical health and couldn’t understand what was happening to me. At times, I felt like I was losing my mind, but I forced myself to act normally, especially since the anxiety and palpitations would eventually go away.

I began to lose focus and interest in all the things that I loved doing before. I didn’t feel well. It was even difficult for me to get out of bed.

Then, an overwhelming sense of exhaustion overtook me. At times, I could barely stay awake. I had no control over it. No matter how hard I tried, I would doze off, almost without warning.

One day, I was driving when that unusual fatigue came over me. I could feel my eyes closing against my will. I pulled into the first parking lot I saw and turned off the motor. ‘I’ll just rest my eyes for minute and I’ll be okay,’ I convinced myself.

I woke up two hours later to the sound of my phone ringing. It hit me then just how perilous a situation I’d put myself in. Here I was, alone and sound asleep for hours in a strange, empty parking lot. Anything could have happened to me!

Getting Tested

That night, I finally told my husband Jim what was happening to me. He immediately recognized my symptoms as being perimenopausal. He arranged to have me tested to rule out any other conditions. One of those tests checked for levels of estrogen and follicle stimulating hormone (FSH). In perimenopause and menopause, estrogen levels fall and FSH levels rise, determining whether the body is either entering or has entered these life cycles.

Though Jim was certain that I was in perimenopause despite my early age, we were both stunned to discover that my estrogen, progesterone, and FSH levels indicated that I was at the very cusp of full menopause.

Hormone Replacement Therapy

I was immediately placed on hormone replacement therapy (HRT). Women who no longer have ovaries, a uterus — or neither — are usually given estrogen only. Since my uterus and ovaries were still intact, I was given both estrogen and progesterone, the latter to prevent endometrial cancer. I began taking it regularly and within three days, I felt like myself again!

Q: There’s so much negativity and controversy regarding HRT. Weren’t you afraid?

Lisa: Not a bit! It gave me back my quality of life. I was monitored carefully. None of the risks I had prevented me from taking estrogen and progesterone, like a history of breast or ovarian cancer, blood clots, stroke, liver disease, or vaginal bleeding. I don’t smoke either, so I was a good candidate.

Q: How long were you on HRT and isn’t it dangerous to use for extended periods?

Lisa: I’m still on it, and I’m still doing fine. I took synthetic hormone replacement in pill form for eight years. Three years ago, I switched to bioidentical hormone replacement therapy, which is a natural, plant-based formula made up of hormones that molecularly are nearly identical to the body’s own hormones. This type of therapy can be adapted to each woman’s individual needs. Though synthetic HRT is perfectly safe in the right dosage, and as long as you have no risk factors, bioidenticals are more natural, and therefore considered more compatible to a woman’s needs. In my case, the cream — which I apply to my arm daily — is made up of progesterone, estrogen and a bit of testosterone. Testosterone is necessary to maintain good muscle and bone health and it also helps regulate mood.

HRT For Life

I’ll most likely be on HRT for life. These hormones are necessary and must be replenished regularly. My mother is 76 and will also be taking HRT for life. She has never had any problems or side effects either.

Without HRT, the body would eventually deplete its own resources and the symptoms I experienced would come back — possibly worse than ever — and possibly accompanied by even more dangerous ones. To me, the choice is obvious.

Cherokee Women’s Health Can Help

If you have questions about perimenopause or are experiencing symptoms, please call 770.720.7733 to make an appointment with one of our providers.

Living with a Prolapsed Bladder

As GYNs, we address bladder issues on a daily basis, so when we discovered that our longtime patient suffered from a prolapsed bladder, we asked her to share her story of life before — and after — bladder surgery.

“I knew every bathroom in town,” recalls Gabrielle, a vibrant woman in her mid-50s, a common age for women to experience bladder problems. “I never leaked – but I had to use the bathroom ALL the time,” she explained. “My husband used to complain, ‘I hate running errands with you because you have to go to the bathroom at every stop.’

“It started in my late 40s, when I began getting this weird feeling that my bladder had ‘fallen’. It got worse and worse, and it just became this constant pressure. It affected everything. When I exercised it was never painful, but I felt this constant sensation of pressure.

“I finally talked to my GYN, and he said it was caused by a prolapsed bladder.”

What is Prolapsed Bladder?

Prolapsed bladder, also known as Fallen Bladder or Cystocele, is a condition where the bladder drops down from lack of support. Pelvic floor muscles and tissues hold the bladder and other organs in place, but they can weaken over time. This causes the bladder to descend from its fixed position and slip downwards into the vagina. In more severe cases, the bladder may dangle completely outside of the vagina.

What Causes Prolapsed Bladder?

There are four main reasons a woman may develop a prolapsed bladder:

Childbirth: A difficult delivery, long labor, a large baby or multiple births

Strain: Heavy lifting, strained bowel movements, excessive coughing

Menopause: Lack of estrogen, which is vital in maintaining the health of vaginal tissue

What are the Symptoms?

A sensation that the bladder is not completely empty right after urinating

Difficulty urinating

Pelvic pain or discomfort

Painful intercourse

Life After Treatment

Gabrielle relates that she was given multiple treatment options but ultimately chose a permanent treatment solution called a surgical bladder lift. “That surgery literally changed my life. It’s been five years, and I’ve never had a problem. AND no more crazy bathroom trips!”

When Should You See Your Doctor?

If you notice that you have any of these symptoms and you suspect a prolapsed bladder, you should see your doctor immediately. This is not a condition that repairs itself. It usually worsens over time. However, it can be fixed, thanks to many modern methods available today.

Why Our FPMRS Specialists are Experts in Bladder Prolapse

Our board-certified OB/GYNs Dr. Michael Litrel, Dr. Peahen Gandhi, and Dr. James Haley have earned board certification in Female Pelvic Medicine and Reconstructive Surgery. FPMRS is a surgical sub-specialty addressing the problems women experience with the changes to their anatomy from having children and pelvic prolapse. FPMRS surgeons are also known as ‘board-certified urogynecologists.’ Cherokee Women’s Health Specialists, PC, has unique surgical expertise in the Southeast United States as an OB/GYN practice with three board-certified urogynecologists.

As I sat in the stirrups waiting for my doctor to come in and give me an O-Shot, in other words, to inject my vagina with a shot of my own blood (PRP), I had to remind myself of why I was there in the first place. I was a bit nervous, but confident that what I was about to endure was the right decision for me.

How it All Started

Last February, I was having one of those days where I just wanted to cuddle up in bed and watch old movies all day. It was rainy, cold, it had been an exhausting week at work, and my kids and husband were getting on my last nerve. I just wanted some “me” time, and quite frankly, I was long overdue for a day to myself.

Cuddling up in my spot in bed, I began flipping the channels. Much to my amazement, I came across one of my all-time faves from the 80s, “When Harry Met Sally.” Classic love stories never get old and I smiled to myself as I started watching, knowing that it was just what I needed.

Even if you haven’t seen the movie, you’ve probably heard of the famous scene where Sally (played by Meg Ryan) graphically acts out a fake orgasm in a restaurant. The room gets deathly quiet as all eyes are on Sally, then another woman promptly tells her waiter, “I’ll have what she’s having!”

The movie came out in the late 80s, and at that time, acting out an orgasm was a bit progressive. Boy have times changed. But after thinking about it for a few minutes, I found myself feeling sad. I realized that I used to have real orgasms just like that. Really. No acting required. What’s happened to me? Why has it changed over the years? This isn’t fair!

Time for a Change

Suddenly my afternoon of movie bingeing became an afternoon of self-reflection. As I’ve gotten older, it’s been rough facing all the shocking truths about my aging body. Health problems here and there, loss of eyesight, aging face, gray hair, menopause, and the ever-increasing weight gain. None of it is easy to face, and aging is not for sissies. It really sucks. But I haven’t really stopped to think about how sex has changed over the years, how it once was, and what it has become for me.

I have a fantastic marriage and husband, so it’s not really about that. It’s more about the feeling during sex — at one time, being practically “earth-shattering,” and then progressing to just being okay or ho-hum. It’s been a slow, gradual decline in pleasure. I can read about it and explain all the medical reasons why, but it’s sad to think that it will most likely continue to get even worse.

I Decided: “I’ll Have what She’s Having!”

The facts are that I’m over 50 and I’ve had three children. I love where I’m at in life and am honestly very grateful. But wouldn’t it be nice if something could bring back that feeling that was once there?

In and Out in 35 Minutes

When I first went in the exam room, the nurse drew my blood, and then my doctor placed numbing cream inside my vagina. This cream was left in place for 20-25 minutes, while they spun my blood in a centrifuge. They then injected my platelet-rich plasma into my clitoris and vaginal wall. Although I slightly felt the shot, it was not painful. I was in and out of the office in 35 minutes. It wasn’t a big ordeal at all, and I had no problem driving myself back to work.

Amazing Results

I could hardly wait to test it. The next day, I positively noticed more feeling in my vagina. It was a warm feeling, as if more blood was circulating, a feeling I recognized from ages ago, but had been reduced over time. When we were finally alone, I practically jumped on my husband. I can honestly say that it was incredible. I hadn’t felt that intense of a feeling during sex for a very long time. And the orgasm was much stronger and longer lasting than it had been in decades. I was blown away, literally, and so thankful to get that feeling back.

5 Months Later

Does it stand the test of time? So far so good. It’s been five months, and it’s still doing the trick. It was a bit more intense the first couple of weeks, but it’s still incredibly better than it was before the shot. Dr. Haley has told me that I can expect it to typically last for a year and possibly longer. As soon as it starts to wear off, I will absolutely be getting another one. It is completely worth it to me.

Highly Recommend

Would I recommend the O-Shot to my friends? Definitely. I know some women who have had the procedure and all have reported positive results. A couple of women have told me they have more intense orgasms, and one has told me her urinary incontinence is much improved.

For me, I think I could do my own personal restaurant scene from “When Harry Met Sally” now, but just for my husband — who by the way, is one very happy guy.